Abstract
Evidence has shown that the trend of increasing obesity rates has continued in the last decade. Mobile phone applications, benefiting from their ubiquity, have been increasingly used to address this issue. In order to increase the applications’ acceptance and success, a design and development process that focuses on users, such as user-centred design, is necessary. This paper reviews reported studies that concern the design and development of mobile phone applications to prevent obesity, and analyses them from a user-centred design perspective. Based on the review results, strengths and weaknesses of the existing studies were identified. Identified strengths included: evidence of the inclusion of multidisciplinary skills and perspectives; user involvement in studies; and the adoption of iterative design practices. Weaknesses included the lack of specificity in the selection of end-users and inconsistent evaluation protocols. The review was concluded by outlining issues and research areas that need to be addressed in the future, including: greater understanding of the effectiveness of sharing data between peers, privacy, and guidelines for designing for behavioural change through mobile phone applications.
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Appendices
Appendix 1: A brief overview of mobile phones applications that were included in the review
Underlying design concept | Targeted users | Role | Aim | Description of application | ||
|---|---|---|---|---|---|---|
1. | Self-awareness | Not explicitly specified | Tracking | Increasing physical activity | A context-aware mobile application that is based on recognition of movement and location capable to enable estimation and evaluation of the user’s activity all day long | |
2. | Self-awareness and social goal setting | Individual with sedentary life style | Enforcing social influence | Increasing physical activities | Users share goals by proposing physical activity challenges to others. Accepted physical activity challenge becomes new goal, and recorded physical activities are shared among users | |
3. | Theory of planned behaviour, theory of meaning behaviour and personality theory | Teenagers | Entertainment | Increasing physical activity | Users’ personalities are identified and used to determine set of games relevant to their personalities. Motivational agent provides encouragement and positive reinforcement. User recorded manually the duration spent to play game | |
4. | Not indicated | Not explicitly specified | Tracking | Monitoring lifestyle | Users are provided with real-time feedback of their caloric intake/expenditure balance throughout the day by capturing their caloric intake through manual entries of food diaries and caloric expenditure through automatic detection of physical activity | |
5. | Goal setting, self-monitoring, positive reinforcement and social support | Teenage girls | Enforcing social influence | Increasing physical activity | Providing a group support system to promote walking towards a self-established daily step goals. Users entered step counts and shared them within the group with text message notification of step updates. Users can send motivating text messages to all or individual members of the group | |
6. | Not indicated | Adolescents | Entertainment | Increasing physical activity | A suite of three different game applications to promote physical activities utilising accelerometer | |
7. | Not indicated | Children and adolescent obesity and overweight | Tracking | Automatic recording of food and physical activity | Users’ physical activities are recorded automatically through motion sensors. Users recorded their food intake by taking photos of each meat at the beginning which are later analysed manually by nutritionist | |
8. | Not indicated | Not explicitly specified | Tracking | Automatic recording of food intake | Users are able to automatically calculate and log the caloric content of over nine thousand types of food, through the use a laser grid and a camera equipped mobile phone. Users are allowed to view an up-to-date summary of their daily eating habits | |
9. | DietCam [39] | Not indicated | Not explicitly specified | Tracking | Automatic recording of food intake | Users take three images or a short video of the meal (prior and after the meal). Images/videos are then used to recognise, classify and estimate the volume and calorie content of the meal |
10. | DiTS [40] | Not indicated | Children with obesity | Entertainment | Increasing physical activity | A mobile phone version of the popular arcade game on dancing. Users worn 3-axis accelerometers that are worn around the players’ ankles which record their legs movement with mobile phones to control the game and to display graphics |
11. | ExerTrek [41] | Not indicated | Not explicitly specified | Tracking | Optimising physical activity’s benefit | An exercise monitor on the mobile phone that will help an individual achieve a certain goal that users want from doing exercise. Once the goals and personal information are set for the individuals, it advises users to achieve the maximal benefits of their exercise without going beyond their own limits |
12. | Not indicated | Not explicitly specified | Entertainment | Increasing outdoor physical activity | An application platform to support physical outdoor exercise. It utilises location information and a mobile phone acts as a terminal device for the game | |
13. | Fitness tour [44] | Not indicated | School children and college students | Entertainment | To increase physical activity | Users are assigned an exercise tour, containing several locations, and shared their achievement through social media. Users’ verification are required at each location. Users’ heart beat were recorded at the start and end of the tour through a mobile phone’s camera |
14. | Not indicated | Not explicitly specified | Tracking | Automatic recording of food intake | Users take photos of their food intake which are then analysed to estimate the nutritional composition of the meals. The food images and their calorie content are stored in a database and accessible to users who can also revise the calorie information | |
15. | Food fight [47] | Not indicated | Adult | Entertainment | Education in nutrition and healthy eating | Introducing competition between users through comparisons of their diets and the rating of their diet |
16. | Persuasive design | Not explicitly specified | Entertainment | Increasing physical activity | Users are required to make certain physical movement while wearing accelerometer as the primary game mechanic | |
17. | HealthAware [50] | Not indicated | Not explicitly specified | Tracking | Monitoring lifestyle | Users monitor daily physical activity through embedded accelerometer and analyse food item by capturing food image with camera. Users are presented with activity counts at real time |
18. | Persuasive design | Individuals with obesity | Enforcing social influence | Increasing physical activity | Users are encouraged to perform physical activity by sharing step count with friends | |
19. | HyperFit [53] | Not indicated | Individuals with overweight issue | Tracking | Mimic personal nutrition counselling | Users are provided with self-evaluation tools for testing and goal definition, food and exercise diaries, analysis tools, and feedback and encouragement given by a virtual trainer |
20. | Not indicated | Adolescents | Entertainment | To increase physical activity | Users’ real world physical movement is used to control their virtual character, interact with Non-Player Character, visit landmarks and collect game items | |
21. | Impact [56] | Self-awareness | People with sedentary life style | Tracking | Monitoring physical activities | Users can capture number of steps, manually input the context of activities and review them on a web |
22. | Into [57] | Not indicated | Not explicitly specified | Tracking | To increase physical activity | The number of steps of a user, automatically recorded by in-built pedometer in a phone, is used to “proceed” (travel virtually) on a map. A use can play as an individual or a member of team |
23. | KnowME [58] | Not indicated | Overweight youth | Tracking | Monitoring physical activities | Users’ biometric signals of users are monitored and visualising users’ level of physical activity and sedentary behaviour |
24. | LocoSnake [59] | Not indicated | Not explicitly specified | Entertainment | To increase physical activity | A player embodies the snake and walks in the physical world to control it and get points |
25. | Luften [60] | Not indicated | Children with obesity or overweight issues | Entertainment | Increasing physical activity | Players are encouraged to move between the different zones through defined routes as their objectives of the game |
26. | Not indicated | Not explicitly specified | Tracking | Monitoring lifestyle | Users are provided with a mobile service that collects data from a variety of health and well-being sensors and presented significant correlations across sensors in a mobile widget as well as on a mobile web application | |
27. | Mobile snack [63] | Social cognitive theory, health belief model, elaboration likelihood model, transportation theory and the precaution adoption process model | Low socioeconomic status families | Tracking | Monitoring food intake | Users are provided with features to input and monitor snacking behaviour and receive feedback on snack healthiness |
28. | Monster and Gold [64] | Not indicated | People with sedentary life style | Entertainment | Trains and motivate users to jog outdoors | Users are provided with a context-aware and user-adaptive game which takes into account their heart rate, age, fitness level, and exercise phase |
29. | Not indicated | Not explicitly specified | Advisory | Trains and motivate users to jog and perform exercise outdoors | User’s positions during physical activity in an outdoor fitness trail are monitored to provide navigation assistance by using a fitness trail map and giving speech directions. An embodied virtual trainer shows how to correctly perform the exercises along the trail with 3D animations | |
30. | Persuasive design | Not explicitly specified | Advisory | Physical activity recommendation | Provides users with and contextualized advice on possible physical activities to do | |
31. | Move2PlayKids [69] | Goal setting, Self-awareness | Children aged 10–18 | Tracking | To increase physical activity | Users’ number of steps is obtained and their activities are inferred through GPS |
32. | Not indicated | Sedentary women | Tracking | Increasing physical activity | The mobile phone serves as a means of delivering the physical activity intervention, setting individualized weekly physical activity goals, and providing self-monitoring (activity diary), immediate feedback and social support. The mobile phone also functions as a tool for communication and real-time data capture | |
33. | Not indicated | Not explicitly specified | Entertainment | Increasing physical activity | Users physical activity are monitored and their level of activities control the animation of their avatars in a virtual race game with other players over the cellular network. Winners are declared every day and players with an excess of activity points are given rewards | |
34. | Transtheoretical model | African American adults in the South-eastern US | Entertainment | Educate nutrition and healthy eating | Users learn how to make healthier meal choices by ordering healthy menu in the game | |
35. | Not indicated | Not explicitly specified | Tracking | Self-monitoring system | Providing a self-monitoring and expert guidance system on physical activities and calorie intakes | |
36. | Self-awareness | Overweight and obese adults | Tracking | Weight management | Users track their caloric balance by recording food intake and physical activity on their mobile phones. Daily reminder messages are also sent via SMS messages to encourage compliance | |
37. | Run, tradie, run [81] | Persuasive design | Not explicitly specified | Entertainment | To increase physical activity | A player can purchase the in-game commodities using points that are earned by performing real physical activity |
38. | Not indicated | Not explicitly specified | Enforcing social influence | Dietetic monitoring and assessment | Users keep daily Personal Health Record (PHR) of their food intake and daily exercise, and to share them with a social network. | |
39. | Transtheoretical model and Social Cognitive Theory | Adult | Enforcing social influence | Increasing physical activity | Users physical activities are tracked through the fluctuation signal strength of their mobile phone and the results are shared with their peer | |
40. | Not indicated | Adolescent girls | Entertainment | To increase physical activity | Promoting physical fitness through addiction to an ongoing and compelling episodic interactive story whose progression is tied to exercise activities | |
41. | Not indicated | Not explicitly specified | Entertainment | Increasing physical activity | Users are encouraged to perform physical activity by solving quests and performing sports | |
42. | StepUp [90] | Not indicated | UAE population | Tracking | Increasing physical activity | It provides sensor-enabled mobile phones to automatically infer the number of steps the user walked and give the user a quantitative measure of his or her daily activities |
43. | Not indicated | Not explicitly specified | Tracking | Automatic recording of food intake | Users take mages of the meal which are then used to recognise, classify and estimate the volume and calorie content of the meal | |
44. | Persuasive design | Children | Entertainment | To motivate healthy eating practice | Users learn about healthy eating by sending photos of the food they consumed to their virtual pet | |
45. | Triple beat [96] | Persuasive design | Runners | Entertainment | To optimise physical activity | assists runners in achieving predefined exercise goals via musical feedback and two persuasive techniques: a glanceable interface for increased personal awareness and a virtual competition |
46. | Goal-setting, Transtheoretical Model of Behaviour Change | Not explicitly specified | Tracking | To increase physical activity | Users can journal and review their physical activities and are shown abstract glanceable display of their physical activities each week on their phone’s background screen | |
47. | Not indicated | Individuals engaged in a weight lost program (meal replacement) | Tracking | Monitoring food intake and weight data | A user is proactively prompted and reminded to interact with the application & initiate health and self-monitoring related tasks | |
48. | Walk2Build [104] | Social participation | Not explicitly specified | Entertainment | To increase physical activity | Recorded GPS data and distance travelled are converted into steps and submitted to a server to create a city which can then be shared with other users |
49. | CBT-based self-management | Not explicitly specified | Tracking | Monitoring lifestyle | Users can journal and review their lifestyle (weight, level of exercise, food intake, etc.) | |
50. | WiFi treasure hunt [109] | Not indicated | School children and college students | Entertainment | To increase physical activity | A user is assigned with a random running tour consisting 10 locations with tree of the selected locations will have “hidden treasures” |
51. | Wockets [110] | Not indicated | Not explicitly specified | Tracking | Monitoring physical activities | Capturing raw motion data to discriminate between activity types or to more accurately estimate energy expenditure |
52. | World of workout [111] | Not indicated | College students and gamers | Entertainment | To increase physical activity | A user levels up by working towards their goals and completing quests by achieving required number of steps |
Appendix 2: A detailed review of mobile phone applications from UCD perspective
Final outcome of studies | UCD key principles | |||||||
|---|---|---|---|---|---|---|---|---|
Understanding of users, tasks and environment | User involvement throughout design and development | Design was driven and refined by user-centred evaluation | Iterative design process | Addressing the whole user experience | Inclusion of multidisciplinary skills and perspective | |||
1. | Fully functioning prototype | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated | Yes | |
2. | Limited functioning prototype | User interviews with limited number of users (despite broad definition of users) for concept development | Users were involved in design concept refinement and evaluation of prototype. Methods adopted were low-fidelity prototyping, video prototyping, interviews and focus group | Yes | Yes | Yes | Yes | |
3. | Fully functioning prototype | Survey and focus group were performed for targeted end-users | Users were involved in concept development and evaluation of prototype | Not indicated | Not indicated | Yes | Yes | |
4. | Fully functioning prototype | Not indicated | Users were involved to validate automatic recognition of physical activities as well as design refinement for food diary (focus groups) | Yes | Yes | Not applicable | Yes | |
5. | Fully functioning prototype | Informal interviews with dietitian; followed by exploratory field interviews and ethnography with targeted end-user | Users were involved in design concept refinement and evaluation of prototype. Methods adopted were low- and high-fidelity prototyping, interviews and questionnaires | Yes | Yes | Yes | Yes | |
6. | Fully functioning prototype | Scenarios were used to explore context of use but no users were involved | Plan to involve user to evaluate high-fidelity prototype | Not indicated | Not indicated | Not applicable | Not indicated | |
7. | Fully functioning prototype | Not indicated | Users were only involved to validate automatic recognition of physical activities | Not indicated | Not indicated | Not indicated | Not indicated | |
8. | Fully functioning prototype | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated | |
9. | DietCam [39] | Fully functioning prototype | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated |
10. | DiTS [40] | Fully functioning prototype | Not indicated | Users were involved in the evaluation of high-fidelity prototype | Not indicated | Not indicated | Yes | Yes |
11. | ExerTrek [41] | Fully functioning prototype | Not indicated | Users were only involved in the evaluation of prototype | Not indicated | Not indicated | Not indicated | Yes |
12. | Fully functioning prototype | Extensive user studies were performed for concept development | Users were involved in design concept refinement and evaluation of prototype. Methods adopted were low- and high-fidelity prototyping, focus groups interviews and questionnaires | Yes | Yes | Yes | Yes | |
13. | Fitness tour [44] | Fully functioning prototype | Not indicated | Users are planned to be involved in the evaluation of the application | Not indicated | Not indicated | Not indicated | Not indicated |
14. | Fully functioning prototype | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated | |
15. | Food fight [47] | Fully functioning prototype | Interviews were conducted with targeted end-users and stakeholders | Users were involved in design concept refinement and evaluation of prototype. Methods adopted were low- and high-fidelity prototyping and interviews | Yes | Yes | Yes | Yes |
16. | Fully functioning prototype | Not indicated | Users were involved in the evaluation of early prototype | Yes | Yes | Yes | Yes | |
17. | HealthAware [50] | Fully functioning prototype | Not indicated | Users were involved to validate automatic recognition of physical activities and a really limited user interface evaluation. | Not indicated | Not indicated | Not indicated | Not indicated |
18. | Fully functioning prototype | Not indicated | Users were involved to validate functions of the prototype | Not indicated | Not indicated | Yes | Yes | |
19. | HyperFit [53] | Fully functioning prototype | Consumer survey and interviews with stakeholders | Users and stakeholders were involved in design concept refinement and evaluation of prototype | Yes | Yes | Yes | Yes |
20. | Fully functioning prototype | End-users and expert interview were performed | Users were involved in concept development and evaluation of prototype | Yes | Yes | Yes | Yes | |
21. | Impact [56] | Fully functioning prototype | End-users studies were performed to establish system features | Users were involved in concept development and evaluation of prototype | Yes | Yes | Yes | Yes |
22. | Into [57] | Fully functioning prototype | End-users studies were performed to refine the concept and design aspects | Users were involved in concept development and evaluation of prototype | Yes | Yes | Yes | Yes |
23. | KnowME [58] | Fully functioning prototype | Not indicated | Users were only involved to validate energy expenditure capturing | Not indicated | Not indicated | Not indicated | Not indicated |
24. | LocoSnake [59] | Fully functioning prototype | Not indicated | Users were involved in the evaluation of prototype | Not indicated | Not indicated | Yes | Not indicated |
25. | Luften [60] | Limited functioning prototype | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated |
26. | Fully functioning prototype | Not indicated | Users were involved in the evaluation of early prototype | Yes | Yes | Yes | Yes | |
27. | Mobile Snack [63] | Fully functioning prototype | Not indicated | Multiple cognitive walkthroughs were used for design concept refinement. Users were only involved in the evaluation of prototype through questionnaire | Yes | Yes | Yes | Yes |
28. | Monster and Gold [64] | Fully functioning prototype | Not indicated | Users were involved in the evaluation of high-fidelity prototype | Yes | Yes | Yes | Yes |
29. | Fully functioning prototype | Not indicated | Users were involved in the evaluation of high-fidelity prototype | Yes | Yes | Not indicated | Yes | |
30. | Fully functioning prototype | Not indicated | Users were only involved in the evaluation of high-fidelity prototype | Not indicated | Not indicated | Not indicated | Yes | |
31. | Move2PlayKids [69] | Limited functioning prototype | Not indicated | Users were involved in the evaluation of a limited functioning prototype | Not indicated | Not indicated | Not indicated | Yes |
32. | Fully functioning prototype | Not indicated | Users were only involved in the evaluation of high-fidelity prototype | Not indicated | Not indicated | Yes | Yes | |
33. | Fully functioning prototype | Not indicated | Users were only involved in the evaluation of high-fidelity prototype | Not indicated | Not indicated | Yes | Yes | |
34. | Fully functioning prototype | Not indicated | Users were only involved in the evaluation of high-fidelity prototype | Not indicated | Yes | Yes | Yes | |
35. | Fully functioning prototype | Not indicated | Users were only involved in the evaluation of high-fidelity prototype | Not indicated | Not indicated | Not indicated | Yes | |
36. | Fully functioning prototype | Scenarios were used to explore context of use but no users were involved | Users were only involved in the evaluation of high-fidelity prototype | Yes | Yes | Yes | Yes | |
37. | Run, tradie, run [81] | Fully functioning prototype | End-users studies were performed to refine the concept and design aspects | Users were involved in concept development and will be included in the evaluation of prototype | Yes | Yes | Yes | Yes |
38. | Fully functioning prototype | Not indicated | Users were only involved in the evaluation of high-fidelity prototype | Not indicated | Not indicated | Yes | Yes | |
39. | Fully functioning prototype | Not indicated | Users were only involved in the evaluation of high-fidelity prototype | Not indicated | Not indicated | Yes | Yes | |
40. | Fully functioning prototype | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated | |
41. | Limited functioning prototype | Evaluation pilot on the concept of SpyFeet | Users were involved in the refinement of the SpyFeet concept | Yes | Yes | Yes | Yes | |
42. | StepUp [90] | Fully functioning prototype | Not indicated | Users were only involved to validate accuracy of the system | Not indicated | Not indicated | Not indicated | Not indicated |
43. | Fully functioning prototype | Not indicated | Users were only involved in the evaluation of high-fidelity prototype | Not indicated | Yes | Yes | Yes | |
44. | Fully functioning prototype | Relevant stakeholders were consulted but no direct users involvement | Users were involved in the evaluation of prototype | Yes | Yes | Yes | Yes | |
45. | Triple beat [96] | Fully functioning prototype | Not indicated | Users were involved in the evaluation of prototype | Not indicated | Not indicated | Yes | Yes |
46. | Fully functioning prototype | Survey to potential users were performed | Users were involved in concept development and evaluation of prototype | Yes | Yes | Yes | Yes | |
47. | Walk2Build [102] | Limited functioning prototype | Not indicated | Users will be involved in the evaluation of a fully functioning prototype | Not indicated | Not indicated | Not indicated | Yes |
48. | Fully functioning prototype | Not indicated | Users were involved in the evaluation of prototype | Not indicated | Not indicated | Not indicated | Not indicated | |
49. | Fully functioning prototype | Not indicated | Users were involved in concept development and evaluation of prototype | Yes | Yes | Yes | Yes | |
50. | WiFi treasure hunt [109] | Fully functioning prototype | Not indicated | Users are planned to be involved in the evaluation of the application | Not indicated | Not indicated | Not indicated | Not indicated |
51. | Wockets [110] | Fully functioning prototype | Participatory design with potential users were performed | Users were involved in concept development | Yes | Yes | Not applicable | Yes |
52. | World of workout [111] | Limited functioning prototype | Not indicated | Users were involved in the refinement of the World of Workout concept | Yes | Yes | Yes | Yes |
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Hermawati, S., Lawson, G. Managing obesity through mobile phone applications: a state-of-the-art review from a user-centred design perspective. Pers Ubiquit Comput 18, 2003–2023 (2014). https://doi.org/10.1007/s00779-014-0757-4
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DOI: https://doi.org/10.1007/s00779-014-0757-4